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19.

FEA DISCOUNT APPLICATION FORM FOR SPRINKLER


INSTALLATION

APPENDIX I
Date:
The Asst. General Manager,
TARIFF ADVISORY COMMITTEE
__________REGIONAL OFFICE.

Dear Sir,
APPLICATION FOR FIRE EXTINGUISHING APPLIANCE(S) DISCOUNT

Risk (Name of the Factory)___________________________


Location ______________________________

As the above Insured have installed sprinkler system in the following blocks,
kindly sanction as from the date of receipt of this application a discount of
_________%.

(The Occupation floorwise and Block No. must be stated)

1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________

I/We enclose plan of the risk with all details marked thereon.

I/We certify that to the best of my/our knowledge and belief the appliances
referred to have been installed in strict accordance with the Rules of the
Committee and I/We also certify that the plan submitted is drawn in
accordance with the Committee`s Rules and is correct and up-to-date.

I/We also certify that a copy of the plan exact in every detail, is available at
the above premises for the use of Committee`s Engineer.

I/We enclose full particulars of the appliances together with letter of


Guarantee signed by the Assured.

Yours faithfully

(Branch Mgr./Divl.Mgr.)

For use of the TAC`s Regional Office only

Date received: Date inspected:

Discount sanctioned: Reference Number:

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APPENDIX II

Date: ____________
The Asst. General Manager,
TARIFF ADVISORY COMMITTEE,
___________REGIONAL OFFICE.

Dear Sir,

GUARANTEE REGARDING FIRE EXTINGUISHING APPLIANCE(S)

In consideration of your Regional Office granting a Discount for the Fire


Extinguishing Appliances detailed on attached/signed form which we have
installed in the (name of factory)____________________________________
situated at _________________________________________________

We hereby engage ourselves: -

1. To maintain and upkeep the said appliances in efficient working order


and where such appliances and Committee’s Rules require the upkeep
of a trained Fire Fighting Personnel to maintain such personnel in an
efficient state.

2. To advise the concerned Regional Office and first obtain permission


should at any time it be necessary to close down supply to pumps or in
any way render the appliances out of operation for repairs, overhaul
etc.

3. Not to extend, alter or demolish protected Blocks/Equipment or to


erect new Block/Equipment in the compound of the premises without
supplying the concerned Regional Office with a revised plan or revising
the plan filed with the concerned Regional Office.

4. To keep at the above described premises a copy exact in every detail of


the plan supplied to your Regional Office, same to be available to the
Regional Office`s Engineer during his visits of inspection.

5. Not to re-number (or re-letter) Blocks, Compartments, etc. as recorded


on the plan filed with the Regional Office without advising the Regional
Office of such revision.

Yours faithfully,

(AUTHORISED SIGNATORY OF THE INSURED )

Note: All communication to the Regional Office of the Committee must be


through the Leading Office on the risk.

APPENDIX III

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Details of Automatic Sprinkler Protection System available at(Name of
factory)________________________________________

1. DETAILS OF THE INSTALLATION:

1.1Pump(s) No.1 No.2 No.3 No.4 Jockey

Type(s) - centrifugal or
vertical turbine etc.

Name plate details

Makers name
Type/model
Impeller size
Discharge
Head
Serial number
R.P.M

1.2Prime mover(s)

Type(s)- electrical
motor/engine driven

Name plate details

Makers name
Type/model
Horse power/BHP/KW
Serial number
Voltage/current
R.P.M
Type of insulation
Fuel tank capacity (L)

1.3 Make and type of


automatic regulator

2. Water supplies

2.1 Source of water


supplies/ inflow
arrangement for fire
water reservoir

2.2Water reservoir

System Demand Resv.1 Resv.2 Resv. Remar


m3 3 ks

Actual provision Fire protection


requirements

3
Sprinkler

Spray

Hydrant

Foam

Note 1: Specify whether the reservoirs are underground, surface or


overhead.
Note 2: Give details on whether the tanks have
independent/common suction or whether the tanks are
interconnected

3. DETAILS OF SPRINKLER INSTALLATION

Installation control valves Sprinklers

protected
Sl.

Blocks
Pressure
No available & Orifice
Size &

Make

Make
Type
type

Nos
plate
Abov Below details
e

4. PIPES

Underground/above ground
Type and method of joining
Make
IS or other equivalent specification
Details of Coating/ wrapping, if any
To what pressure have the pipes been tested

5. TESTING AND MAINTENANCE OF THE SYSTEM:

i) Whether the Installation Control valves/alarm bell provided at the


premises tested/examined/operated at least once in 3 months.

ii) Frequency of checking/cleaning of valve seat.

iii) Frequency of pump(s) testing with remarks.

iv) Are the records of all tests and defects maintained.

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v) Number of Sprinkler Heads : readily available at stock.

Place:

Date:

SIGNATURE.

(FORM TO BE SIGNED BY THE OWNER OF THE PREMISES).

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